Strength-Training Exercise in Dysphagia Rehabilitation: Principles, Procedures, and Directions for Future Research

AbstractDysphagia rehabilitation, historically, has focused a great deal on various compensations during swallowing to prevent aspiration and/or improve safety and efficiency. Exercise, in general, has been a part of the dysphagia rehabilitation landscape. However, heightened discussions in the field regarding best practices for exercise training, particularly strengthening, raise more questions than answers. The intent of this paper is to (1) explore the overriding principles of neuromuscular plasticity with regard to strength training, (2) evaluate how current exercise-training interventions in dysphagia rehabilitation correspond to these principles, and (3) postulate directions for future study of normal and disordered swallowing and determine how to incorporate these principles into dysphagia rehabilitation.

[1]  A. L. Watkins,et al.  Technics of progressive resistance exercise. , 1948, Archives of physical medicine and rehabilitation.

[2]  H. Huxley,et al.  Changes in the Cross-Striations of Muscle during Contraction and Stretch and their Structural Interpretation , 1954, Nature.

[3]  A. Huxley,et al.  Structural Changes in Muscle During Contraction: Interference Microscopy of Living Muscle Fibres , 1954, Nature.

[4]  Progressive resistance exercise. , 1959 .

[5]  A test of the DeLorme axiom. , 1968, Archives of physical medicine and rehabilitation.

[6]  P. Bonanno Swallowing Dysfunction after Tracheostomy , 1971, Annals of surgery.

[7]  G S Pechar,et al.  Specificity of swim training on maximum oxygen uptake. , 1975, Journal of applied physiology.

[8]  S. L. Schwartz,et al.  Deglutition After Conservation Surgery for Cancer of the Larynx and Hypopharynx , 1979, Otolaryngology and head and neck surgery.

[9]  T. Moritani,et al.  Neural factors versus hypertrophy in the time course of muscle strength gain. , 1979, American journal of physical medicine.

[10]  T. Moritani,et al.  Potential for gross muscle hypertrophy in older men. , 1980, Journal of gerontology.

[11]  R. Hickson,et al.  Strength training effects on aerobic power and short-term endurance. , 1980, Medicine and science in sports and exercise.

[12]  E Stålberg,et al.  Macro EMG in healthy subjects of different ages. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[13]  J. Logemann,et al.  Evaluation and treatment of swallowing disorders , 1983 .

[14]  J. Logemann,et al.  Aspiration in Head and Neck Surgical Patients , 1985, The Annals of otology, rhinology, and laryngology.

[15]  B. Essén-Gustavsson,et al.  Histochemical and metabolic characteristics of human skeletal muscle in relation to age. , 1986, Acta physiologica Scandinavica.

[16]  A J Sargeant,et al.  Strength training and power output: transference effects in the human quadriceps muscle. , 1986, Journal of sports sciences.

[17]  W. Brown,et al.  Methods for estimating numbers of motor units in biceps‐brachialis muscles and losses of motor units with aging , 1988, Muscle & nerve.

[18]  M. Sjöström,et al.  What is the cause of the ageing atrophy? Total number, size and proportion of different fiber types studied in whole vastus lateralis muscle from 15- to 83-year-old men , 1988, Journal of the Neurological Sciences.

[19]  D. Sale,et al.  Positive adaptations to weight-lifting training in the elderly. , 1990, Journal of applied physiology.

[20]  B. Lateur,et al.  The Importance of Skeletal Muscle Strength to Physical Function in Older Adults , 1991, Annals of Behavioral Medicine.

[21]  G. Tucker,et al.  Clinical Measurement in Drug Evaluation , 1991 .

[22]  P J Kahrilas,et al.  Volitional augmentation of upper esophageal sphincter opening during swallowing. , 1991, The American journal of physiology.

[23]  R. Vlietinck,et al.  The use of twins in dentofacial genetic research. , 1993, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[24]  A. Rademaker,et al.  Changes in pharyngeal dimensions effected by chin tuck. , 1993, Archives of Physical Medicine and Rehabilitation.

[25]  T Moritani,et al.  Neuromuscular adaptations during the acquisition of muscle strength, power and motor tasks. , 1993, Journal of biomechanics.

[26]  A. Rademaker,et al.  Chin-down posture effect on aspiration in dysphagic patients. , 1993, Archives of physical medicine and rehabilitation.

[27]  R. Segal,et al.  Genioglossi muscle activity in response to changes in anterior/neutral head posture. , 1993, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[28]  A. Rademaker,et al.  Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture. , 1993, AJR. American journal of roentgenology.

[29]  K. E. Lugger,et al.  Dysphagia in the Elderly Stroke Patient , 1994, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[30]  P J Kahrilas,et al.  Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. , 1994, Journal of speech and hearing research.

[31]  M. Heliövaara,et al.  The physical activity of healthy and chronically ill adults in Finland at work, at leisure and during commuting , 1994 .

[32]  D. Buchholz,et al.  Dysphagia associated with neurological disorders. , 1994, Acta oto-rhino-laryngologica Belgica.

[33]  R. Petrella Exercise Training and Nutritional Supplementation for Very Elderly People , 1994 .

[34]  Buchholz Dw,et al.  Dysphagia Associated With Neurological Disorders , 1994 .

[35]  P. Pouderoux,et al.  Deglutitive tongue force modulation by volition, volume, and viscosity in humans. , 1995, Gastroenterology.

[36]  D. Eibling,et al.  Effect of the Passy‐Muir valve on aspiration in patients with tracheostomy , 1995, Head & neck.

[37]  I R Odderson,et al.  Swallow management in patients on an acute stroke pathway: quality is cost effective. , 1995, Archives of physical medicine and rehabilitation.

[38]  A. McComas,et al.  Motor unit estimation: Anxieties and achievements , 1995, Muscle & nerve.

[39]  C. Lazarus,et al.  Swallowing Disorders in Head and Neck Cancer Patients Treated With Radiotherapy and Adjuvant Chemotherapy , 1996, The Laryngoscope.

[40]  E H Wagner,et al.  Evidence for a non-linear relationship between leg strength and gait speed. , 1996, Age and ageing.

[41]  J. Chandler,et al.  Exercise to improve physiologic and functional performance in old age. , 1996, Clinics in geriatric medicine.

[42]  J. Logemann,et al.  Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition , 1996 .

[43]  S. Bloomfield,et al.  Changes in musculoskeletal structure and function with prolonged bed rest. , 1997, Medicine and science in sports and exercise.

[44]  C. Rice,et al.  Age‐related changes in motor unit function , 1997, Muscle & nerve.

[45]  M. Schultz,et al.  A model for conducting clinical-outcome research: An adaptation of the standard protocol for use in aphasiology , 1998 .

[46]  Hirofumi Tanaka,et al.  Impact of resistance training on endurance performance. A new form of cross-training? , 1998 .

[47]  W J Kraemer,et al.  Changes in agonist-antagonist EMG, muscle CSA, and force during strength training in middle-aged and older people. , 1998, Journal of applied physiology.

[48]  Acsm Position Stand. ACSM Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults , 1998 .

[49]  J. Robbins,et al.  Comparing Treatment Intensities of Tactile-Thermal Application , 1998, Dysphagia.

[50]  Michael P. Cannito,et al.  Outcomes of Swallowing Rehabilitation in Chronic Brainstem Dysphagia: A Retrospective Evaluation , 1999, Dysphagia.

[51]  W J Kraemer,et al.  Training for muscular power. , 2000, Physical medicine and rehabilitation clinics of North America.

[52]  B L Tracy,et al.  Age and gender responses to strength training and detraining. , 2000, Medicine and science in sports and exercise.

[53]  K. Häkkinen,et al.  Neuromuscular adaptation during prolonged strength training, detraining and re-strength-training in middle-aged and elderly people , 2000, European Journal of Applied Physiology.

[54]  L. Melton,et al.  Excess Mortality Following Vertebral Fracture , 2000, Journal of the American Geriatrics Society.

[55]  J C Rothwell,et al.  Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke. , 2000, Clinical science.

[56]  M NessAiver,et al.  Effects of strength training and detraining on muscle quality: age and gender comparisons. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[57]  Graeme J. Hankey,et al.  Swallowing Disorders following Acute Stroke: Prevalence and Diagnostic Accuracy , 2000, Cerebrovascular Diseases.

[58]  L. Melton,et al.  Epidemiology of sarcopenia. , 2000, Journal of the American Geriatrics Society.

[59]  N. P. Reddy,et al.  Biofeedback therapy using accelerometry for treating dysphagic patients with poor laryngeal elevation: case studies. , 2000, Journal of rehabilitation research and development.

[60]  Calcium oxalate crystallization kinetics studied by oxalate-induced turbidity in fresh human urine and artificial urine. , 2000 .

[61]  A. Jette,et al.  Have we oversold the benefit of late-life exercise? , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[62]  I. Holm,et al.  Design and implementation of a neuromuscular training program following anterior cruciate ligament reconstruction. , 2001, The Journal of orthopaedic and sports physical therapy.

[63]  J. Robbins,et al.  Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. , 2001, Archives of physical medicine and rehabilitation.

[64]  G. Throckmorton,et al.  The effects of isometric exercise on maximum voluntary bite forces and jaw muscle strength and endurance. , 2001, Journal of oral rehabilitation.

[65]  A. Newman,et al.  Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. , 2001, Journal of applied physiology.

[66]  L. Cohen,et al.  Mechanisms underlying human motor system plasticity , 2001, Muscle & nerve.

[67]  W. Baine,et al.  Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998. , 2001, American journal of public health.

[68]  The effects of isometric exercise on maximum voluntary bite forces and jaw muscle strength and endurance. , 2001 .

[69]  Charles R. Larson,et al.  Surface Electromyographic and Electroglottographic Studies in Normal Subjects Under Two Swallow Conditions: Normal and During the Mendelsohn Manuever , 2001, Dysphagia.

[70]  V. Raut,et al.  Effect of bolus consistency on swallowing – does altering consistency help? , 2001, European Archives of Oto-Rhino-Laryngology.

[71]  I. Mujika,et al.  Muscular characteristics of detraining in humans. , 2001, Medicine and science in sports and exercise.

[72]  Roberta B. Shepherd,et al.  Exercise and Training to Optimize Functional Motor Performance in Stroke: Driving Neural Reorganization? , 2001, Neural plasticity.

[73]  W. Kraemer,et al.  Performance and Physiologic Adaptations to Resistance Training , 2002, American journal of physical medicine & rehabilitation.

[74]  E. Ward,et al.  Swallowing outcomes following laryngectomy and pharyngolaryngectomy. , 2002, Archives of otolaryngology--head & neck surgery.

[75]  A. Kenny,et al.  Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[76]  D. Sale,et al.  Postactivation Potentiation: Role in Human Performance , 2002, Exercise and sport sciences reviews.

[77]  Reza Shaker,et al.  Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. , 2002, Gastroenterology.

[78]  Maintenance of whole muscle strength and size following resistance training in older men. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[79]  S. Langmore,et al.  Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001. , 2002, Journal of rehabilitation research and development.

[80]  S. Powers,et al.  Adaptation of upper airway muscles to chronic endurance exercise. , 2002, American journal of respiratory and critical care medicine.

[81]  Jeri Logemann,et al.  Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT®): a pilot study , 2002, INTERSPEECH.

[82]  M. Macdermott,et al.  The effects of chronic episodic hypercapnic hypoxia on rat upper airway muscle contractile properties and fiber-type distribution. , 2002, Chest.

[83]  A. Rademaker,et al.  Effects of Voluntary Maneuvers on Tongue Base Function for Swallowing , 2002, Folia Phoniatrica et Logopaedica.

[84]  A. Rademaker,et al.  Effects of Two Types of Tongue Strengthening Exercises in Young Normals , 2003, Folia Phoniatrica et Logopaedica.

[85]  Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury , 2003, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[86]  Letha Y Etty Griffin Neuromuscular training and injury prevention in sports. , 2003, Clinical orthopaedics and related research.

[87]  C. Irvin,et al.  Exercise Physiology , 2003, Springer New York.

[88]  H. Clark Neuromuscular treatments for speech and swallowing: a tutorial. , 2003, American journal of speech-language pathology.

[89]  J. Grayhack,et al.  Physiologic Effects of Open and Closed Tracheostomy Tubes on the Pharyngeal Swallow , 2003, The Annals of otology, rhinology, and laryngology.

[90]  Matthew R Rhea,et al.  A meta-analysis to determine the dose response for strength development. , 2003, Medicine and science in sports and exercise.

[91]  Raymond D. Kent The uniqueness of speech among motor systems , 2004, Clinical linguistics & phonetics.

[92]  J. Kleim,et al.  Cortical Synaptogenesis and Motor Map Reorganization Occur during Late, But Not Early, Phase of Motor Skill Learning , 2004, The Journal of Neuroscience.

[93]  K. Watkin,et al.  The influence of bolus volume and viscosity on anterior lingual force during the oral stage of swallowing , 1996, Dysphagia.

[94]  S. Langmore,et al.  The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration , 2004, Dysphagia.

[95]  Ellen B. Roecker,et al.  A penetration-aspiration scale , 2004, Dysphagia.

[96]  J. Rosenbek,et al.  Thermal application reduces the duration of stage transition in dysphagia after stroke , 2004, Dysphagia.

[97]  C. Larson,et al.  Viscosity effects on EMG activity in normal swallow , 2004, Dysphagia.

[98]  M. Reding,et al.  Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke , 2004, Dysphagia.

[99]  P. Davis,et al.  The effects of cold, touch, and chemical stimulation of the anterior faucial pillar on human swallowing , 2004, Dysphagia.

[100]  M. Crary A direct intervention program for chronic neurogenic dysphagia secondary to brainstem stroke , 2004, Dysphagia.

[101]  D. Buchholz,et al.  Oropharyngeal dysphagia due to iatrogenic neurological dysfunction , 2004, Dysphagia.

[102]  B. J. Martin,et al.  The association of swallowing dysfunction and aspiration pneumonia , 2004, Dysphagia.

[103]  N. Toraman Short term and long term detraining: is there any difference between young-old and old people? , 2005, British Journal of Sports Medicine.

[104]  C. Lazarus Lingual Strengthening and Swallowing , 2005 .

[105]  Jaeock Kim,et al.  Implications of expiratory muscle strength training for rehabilitation of the elderly: Tutorial. , 2005, Journal of rehabilitation research and development.

[106]  Reza Shaker,et al.  Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise , 2005, Dysphagia.

[107]  The Role of Exercise Programs for Dysphagia Patients , 2005, Dysphagia.

[108]  L. Ramig,et al.  Perspectives on Swallowing Disorders and Their Treatment in Parkinson's Disease With Emphasis on the Lee Silverman Voice Treatment , 2005 .

[109]  J. Logemann,et al.  Swallow physiology in patients with trach cuff inflated or deflated: A retrospective study , 2005, Head & neck.

[110]  P. Clarkson,et al.  Immobilization effects in young and older adults , 2006, European Journal of Applied Physiology.

[111]  JoAnne Robbins,et al.  The Effects of Lingual Exercise on Swallowing in Older Adults , 2005, Journal of the American Geriatrics Society.

[112]  D. Castell,et al.  Effect of head position on the dynamics of the upper esophageal sphincter and pharynx , 2005, Dysphagia.

[113]  C. Steele,et al.  An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressure during effortful swallow. , 2006, Archives of physical medicine and rehabilitation.

[114]  Christine M. Carmichael,et al.  Tutorial on maximum inspiratory and expiratory mouth pressures in individuals with idiopathic Parkinson disease (IPD) and the preliminary results of an expiratory muscle strength training program. , 2006, NeuroRehabilitation.

[115]  T. Marrie,et al.  Reasons for coming to hospital after treatment for community-acquired pneumonia on an ambulatory basis. , 2006, Canadian respiratory journal.

[116]  Per Aagaard,et al.  Neuromuscular activation in conventional therapeutic exercises and heavy resistance exercises: implications for rehabilitation. , 2006, Physical therapy.

[117]  P. Davenport,et al.  Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough. , 2006, Archives of physical medicine and rehabilitation.